Provider Demographics
NPI:1508925322
Name:BENEDICT, NANNETTE (DDS)
Entity Type:Individual
Prefix:
First Name:NANNETTE
Middle Name:
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 SCOTTS VALLEY DR
Mailing Address - Street 2:STE A
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4209
Mailing Address - Country:US
Mailing Address - Phone:831-440-9214
Mailing Address - Fax:831-438-6412
Practice Address - Street 1:5015 SCOTTS VALLEY DR
Practice Address - Street 2:STE A
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4209
Practice Address - Country:US
Practice Address - Phone:831-440-9214
Practice Address - Fax:831-438-6412
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice